Get moving on Medicaid

With the economic health of the state and the health care industry in the balance, it is time for the Missouri General Assembly to get serious about expanding Medicaid.

And it is time for voters to give their legislators a reason to step out and seriously consider opting into the federal government's Medicaid plan. In fact, it is up to voters to give their legislators the political cover they need to take that step.

While the majority of Missourians and Republican legislators have made it clear they don't like Obamacare, refusing the Medicaid expansion as a way to double down on that distaste is dangerous on many levels.

A little history is in order. When the Affordable Care Act - Obamacare - was first negotiated, hospitals and other health care providers agreed to a reduction in payments from Medicare and Medicaid to be offset by an expansion in Medicaid that would mean fewer uninsured and nonpaying patients.

When the U.S. Supreme Court ruled that Obamacare is legal, but the mandate that states expand their Medicaid rolls was not, it changed the landscape. The federal government provided substantial incentives for states to participate, but some have continued to hold back, expressing both economic and political concerns.

Two important Republican governors - Chris Christie in New Jersey and Rick Scott in Florida - have recently changed their positions, which could be a harbinger of change around the country. But the political fallout for many Republican lawmakers has made accepting this important element of Obamacare difficult.

For those in the health care industry, not accepting expansion of Medicaid could be catastrophic because that first part of the deal - reduction in payments - is still part of the package. In fact, it has already started.

By the end of 2019, those cuts are predicted to total $4 billion to hospitals across the state. For CoxHealth alone, that cost could equal $47 million.

That level of cutting will have an impact. It will mean some hospitals, especially small ones in rural areas, will have to close, people will lose their jobs, hospitals will cut back on capital investments, and those of us who have private insurance will have to pay more.

On the other hand, if Missouri opts into Medicaid expansion, it will bring in a projected $15.7 billion in federal funding through 2021. The federal program provides for 100 percent federal funding in 2014-16, then dropping to 95 percent and ultimately 90 percent by 2020.

A University of Missouri at Columbia study predicts that expansion would also generate more than 24,000 jobs in 2014 - the first year the expansion is set to go into effect. Our region is predicted to get 13.8 percent of those jobs.

The Missouri Office of Administration, Budget and Planning puts savings and revenue from the expansion at more than $140 million a year through 2021. Even as expenditures catch up, the office predicts revenue will always stay above costs.

Additional revenue is also projected through job growth and other sources directly related to expanding Medicaid.

But money is not the only reason to embrace the expansion. People and their health are important reasons.

With the "working poor" representing more than half of Missouri's uninsured, we would be providing access to health care coverage to people who work in restaurants, construction, housekeeping, retail sales, agriculture, child care, even teachers and those in health care services. We know that insured workers are healthier workers and healthier neighbors.

Those nearly 107,000 workers who could benefit from the expansion would no longer have to use emergency rooms as their primary medical care, keeping costs down and making our ERs more effective for those who are experiencing a medical emergency.

And, that would lower the costs for everyone, especially those who pay for private insurance.

This is uncharted waters for Missouri and the other states. While the federal government has promised funding, many legislators and voters are concerned that in this economic climate that promise may fall through in the future. Several states have rightfully included escape clauses in their legislation that would address that possibility.

Missouri's strongly Republican General Assembly has expressed those concerns, as well, but some legislation has been filed to start talking about ways to overcome them and take advantage of what Obamacare can offer.

Most recently, Rep. Jay Barnes, R-Jefferson City, offered his bill, which he calls a "market-based Medicaid" program that would require private insurers to compete to cover lower-income patients in the government-funded program.

While the bill puts eligibility for Medicaid below the federal government's level, it is a good starting point for debate. However, the bill will never make it to the floor for a vote if there isn't enough Republican support to guarantee a win. That is the political reality - and, in the end, this is all about politics.

That is where you come in. It is up to the voters to let their legislators know that they support a balanced, smart approach to Medicaid expansion and that they will continue to support legislators who vote for that kind of approach.

Our lawmakers need your support and they need your political cover - just as badly as our working poor need health care coverage.

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Get moving on Medicaid

With the economic health of the state and the health care industry in the balance, it is time for the Missouri General Assembly to get serious about expanding Medicaid.